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    <title>代理授权申请</title>
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    </title></head>
<body>

<div id="aside_container">
</div>
<div id="section_container">
    <section id="index_section" class="active">

        <style>
            .imageFrame {
                width: 130px;
                margin: 10px;
                border: 6px solid rgba(200,200,200,0.2);
                background: rgba(200,200,200,0.1);
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            .imageFrame input {
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            .imageFrame p {
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                text-align: center;
                font-size: 14px;
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            .imageFrame img {
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        </style>


        <header>
            <nav class="left">

                <a href="/" data-icon="previous" data-target="back"><img src="/image/backn.png">登录</a>
            </nav>
            <h1 class="title" style="color:#ffffff;background: #000;">代理授权申请                </h1>
            <nav class="right">
                <a data-target="section" data-icon="info" href="#" id="manualBtn"> </a>                </nav>

        </header>

        <div id="mcover" onclick="document.getElementById('mcover').style.display='';"><img src="/image/guide.png"></div>

        <div id="codelListArea">
            <div class="weinxPlane">


                <form name="frmShareUrl" method="post" action="/invite/registerdo" id="frmShareUrl">

                    <div class="control-group">
                        <p>上级代理人:{{$data['agent_name']}}&nbsp;&nbsp; </p>
                        <p>上级授权号:{{$data['accredit_no']}}</p>
                    </div>


                    <div class="">
                        <input id="Customer_ID" name="upid" value="1666" type="hidden">
                        <input type="hidden" name="pid" value="{{$data['id']}}">
                        <select name="lev">

                            <option value="{{$lev['lev']}}">{{$lev['lev_name']}}</option>

                        </select>

                        <div class="input-row">
                            <label for="Name" style="font-size:14px;">授权人姓名</label>
                            <input name="agent_name" value="" maxlength="30" placeholder="授权人姓名" value="" type="Text">
                        </div>

                        <div class="input-row">
                            <label for="WeChat" style="font-size:14px;">微信号</label>
                            <input name="wx" value="" maxlength="20" placeholder="6-20个字母、数字、下划线" type="Text">
                        </div>

                        <div class="input-row">
                            <label for="Phone" style="font-size:14px;">手机号</label>
                            <input name="tel" value="" maxlength="11" placeholder="手机号" type="Text">
                        </div>
                        <div class="input-row">
                            <label for="IdCardNo" style="font-size:14px;">身份证</label>
                            <input name="idcard" value="" maxlength="18" placeholder="身份证号码" type="Text">
                        </div>
                        {{--<div class="input-row">--}}
                            {{--<label for="IdCardNo" style="font-size:14px;">开户银行</label>--}}
                            {{--<select name="bank_name" style="font-size:16px;height:34px;width:100%">--}}
                                {{--<option value="">选择开户银行</option>--}}
                                {{--<option value="中国银行">中国银行</option>--}}
                                {{--<option value="中国工商银行">中国工商银行</option>--}}
                                {{--<option value="中国建设银行">中国建设银行</option>--}}
                                {{--<option value="中国农业银行">中国农业银行</option>--}}
                            {{--</select>--}}
                        {{--</div>--}}
                        {{--<div class="input-row">--}}
                            {{--<label for="IdCardNo" style="font-size:14px;">账号</label>--}}
                            {{--<input name="bankno" value="" maxlength="20" placeholder="银行账号" type="tel">--}}
                        {{--</div>--}}
                        <div class="input-row">
                            <label for="CustomField5" style="font-size:14px;">地址</label>
                            <input name="area" value="" maxlength="80" placeholder="地址" type="Text">
                        </div>

                        <span style="line-height:40px;padding-left:10px;font-size:14px;">通过审核后，登录密码为：123456</span>

                    </div>


                    <input name="btnlogin" value="提交" id="btnSubmit" class="button block" required="required" style="background-color: rgb(0, 0, 0);" type="submit">



                </form>



            </div>
        </div>


        <div style="height: 60px;">

        </div>


    </section>

</div>

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